Thursday, October 16, 2014

Laurie Garrett: "I think our biggest challenge in the U.S. is hubris" (PBS interview on Ebola)

It was almost shocking to hear a guest on the PBS Newshour last night, one steeped in the intricate details of the Ebola crisis, diagnose the biggest problem facing America over this crisis as
HUBRIS.
Laurie Garrett is a Fellow at the Council of Foreign Relations, and has been writing about the relationship between what are termed medical crises and their impact on the effectiveness of states to function.
Here is a quote from her interview with Judy Woodruff from the program last night:

LAURIE GARRETT:I think our biggest challenge in the United States is hubris. We have consistently heard and said — and, by the way, it’s not just the government saying this. It’s been all the public health associations, the American Medical Association, all the major physician groups and so on — for quite some time saying, look, what’s going on over there in Africa is the result of inadequate health systems, poor hygiene and so on. It wouldn’t be like that here in America. We know how to do this.And I think it is kind of a smug attitude. And it’s very similar and reminiscent to a similar smug sense of self-assurance that dictated the response Canada had to the arrival of SARS in the Toronto hospital system in 2003.When you contrast how quickly Vietnam in its poverty managed to control SARS in 2003, compared to how long — it just kept coming back again and again in the hospital system in Toronto — it shows that there’s a certain arrogance that happens with technology. We sort of think, well, we have this high-tech equipment, we can stop it.But there’s a lot more to stopping the spread of a virus than just high-tech equipment.
There is not only cogent truth in her statement but also extreme danger.
The world can thank the Americans for many things, among them a buoyant spirit and level of hope in the midst of dark times that can keep the discussion going long after many other participants would have become exhausted. It is their ebullience and their history not only of military (revolutionary) actions but their celebration of the "warriors" of those engagements that undergirds their national consciousness. The Americans, one could argue, suffer from a surfeit of self-confidence. It is evident not only in the public statements of their CDC leaders starting back in August that "we can and will contain this virus" to their military commanders believing that they can and will destroy ISIS with their bombs, missiles and superior intelligence. Their athletic stars believe, and are drilled into a full assimiliation of the belief, that they will win each and every game. The attitude is so prevalent that, should anyone express honest doubt about the outcome of a "game," s/he is alienated from the inner circle of those about to take to the field.
Winning, in all of its many forms, shapes and sizes, is something that infuses all actions of all Americans no matter how dire the circumstances they face, except that such an addiction to winning and to preserving the American tradition of winning inevitably blinds many of their citizens to the fullness of the reality they face.
Championing their "best" military, and "best" health care system and "best" school system, and "largest"economy, and "most productive" work force, and "most innovative" corporations and "best universities" in the world and "most open" society, and "most developed" democracy, and "most tolerant" culture in race relations, and "most heroic" turn-arounds in medical distress....all of these have some truth in their core. Collectively, however, this way of seeing the world, from the inside of a gigantic bubble of magnifying glass, necessarily limits the range of the comparisons implicit in the lens, and exaggerates the size, significance and importance of the accomplishments and their nation. It also imbues their people with a belief, verging on a religious belief, that their's is the best of everything there is to life. The belief serves also as a magnet drawing millions to their shores from every corner of the world every year, some even risking death in the process in skiffs unworthy of a calm inland lake, not to mention the winds and waves of the largest oceans. Of course, the conditions from which those aspiring immigrants hope to escape are also significant motivators in their pitiable journey.
This "best-ness" belief militates other dangerous and complicating approaches. It sees, for example, all human endeavours as competitions, and then makes the implicit demand that one decides if one wishes to 'enter the playing field' and engage in the specific "game" because entering implies the goal of winning. So, rather than lose, many "games" have to be abandoned, because winning supplants engagement and relegates many to their own "games" in order to achieve the success in their personal lives that qualifies them as "acceptable" and role models in the culture, the neighbourhood and even in the family. Being the best also brings with it the danger that no matter the crisis, "we" Americans can and will solve it, bring it to heel and overcome the highest and most threatening obstacles.
And indeed, there is historic evidence that, over time, the Americans have overcome considerable obstacles, but not all, and not all in a timely manner.
And in a crisis like the global pandemic of Ebola, in which, for example, all figures of the size and scope of the devastation in Liberia are simply untrustworthy, so damaged are the systems required to take counts American hubris/complacency/insouciance and disengagement for many reasons lies at the heart of the American effort to first enter the "game" and then to defeat the enemy. Laurie Garrett herself proclaimed that the numbers of infected persons in that country, far from the 9000 public estimates, rises above 20,000 and the numbers of dead from Ebola in that country alone, far from the 4-5000 reaches into the high teens, more like 15-17000.
The American culture has so 'sacralised' winning, being number one, the best, that it verges on drowning in its own unbalanced and exaggerated sense of its own power. No public figure, no leader of any organization, including one like the Centre for Disease Control (CDC) dare utter a statement of doubt about the capacity of the organization s/he leads, for fear of being politically "decapitated" by both the media and the rest of that organization. And yet, just this past year, General Motors, for one, has recalled more than 15,000,000 vehicles some of them because human lives have been lost as the price of carelessness in the quality control processes of the largest corporation in world history.
Being number one generates a conviction that not only are we doing everything "right" but also if we make a slight mistake, no one will notice because everyone else is so busy in their own private competitions that they will be too pre-occupied to notice and to do anything about an oversight.
The New York Times is now reporting that American military personnel who have been assigned to dismantle weapons in Iraq following both wars in that country, have found and detonated weapons that contained deadly chemicals, not the weapons of mass destruction that provoked George W. Bush's war on Saddam Hussein, but weapons created in the 1980's when Iraq was at war with Iran. Those American military personnel who were charged with the deactivation of those weapons were severely burned with mustard gas and potentially nerve gas, while their American superiors were unable (or unwilling) to acknowledge the seriousness of their wounds. They had to mount an information offensive just to convince their superiors of the truth of their plight, yet when they did arrive at Walter Reid hospital for military veterans, the doctors did confirm that they were suffering from mustard gas wounds.
Liberia, Sierra Leone, Nigeria.....these are countries far from the American shore, and even farther from the American consciousness. Ebola, however, is a virus that is currently flying around the planet in planes and in human bodies unknown and undocumented to the World Health Organization and to the American CDC, as well as to the public health communities in all countries around the world.
If we are to contain and potentially eradicate this plague, and if we are to depend on American leadership, we will have to contend with American arrogance and hubris and the resulting failures of omission, commission and general insouciance, along with the intimate details of the virus.
There are many labs working on a medical treatment for the Ebola virus, some of which are about to go into clinical trials, faster than the bioscience sector has ever moved in history; and for that, all people, including both those suffering from the Ebola virus and those not yet infected, can be and are grateful.
There is, however, no known vaccination for hubris, for complacency and for insouciance that infect too many of the attitudes and approaches and actions and words of too many "leaders" on whom the world depends, including too many American experts. And it will not be through open and public criticism of such attitudes that they will be modified. It will only come through a conscious realization that such attitudes impede the effort to bring this virus under control. It will only be through the mounting evidence that "someone dropped the ball" when they considered first whether Thomas Eric Duncan had health insurance when he first appeared at Dallas Health Presbyterian, rather than whether he exhibited symptoms of Ebola, and thereby sent him away, because he was not covered by health insurance, or when someone at the CDC did not consider a temperature of 99.4 to be in the danger zone of an Ebola patient, and therefore did not restrict the nurse from taking a public flight from Ohio to Dallas, thereby potentially infecting other passengers on that flight.
Winners are obsessed with the details of their own game, not with the larger picture of how we all might be in another and larger and more dangerous game of survival. Hubris is a virus for which there is no known cure or even a known "moderating" and impeding vaccination.
And we all have our own hubris pulsing through our veins and arteries, nudging sometimes helpful decisions and actions, sometimes not so much.
Have the Americans on whom the world is depending to contain and to eradicate this epidemic managed to bring their hubris demon under control, in order to fully engage in a struggle for their's and our survival?